Provider Demographics
NPI:1033727243
Name:SIMPLY MARVELOUS HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:SIMPLY MARVELOUS HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KANYIA
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-692-8849
Mailing Address - Street 1:1035 W 25TH ST STE D2
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1000
Mailing Address - Country:US
Mailing Address - Phone:757-692-8849
Mailing Address - Fax:
Practice Address - Street 1:1035 W 25TH ST STE D2
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1000
Practice Address - Country:US
Practice Address - Phone:757-692-8849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health